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Get the free OHA 3128. Provider Enrollment Addendum for Application Assistance Provider Locations

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Get the OHA 3128 Provider Enrollment Addendum for Application Assistance Provider Locations. Description. DIVISION OF MEDICAL ASSISTANCE ...
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How to fill out oha 3128 provider enrollment

01
Step 1: Obtain the OHA 3128 provider enrollment form.
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Step 2: Read the instructions and form carefully to understand the requirements and necessary information.
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Step 3: Provide all the required personal information, such as name, contact details, and social security number, as requested on the form.
04
Step 4: Fill in the details of your professional qualifications and credentials, including your license number, education, certifications, and any relevant training.
05
Step 5: If applicable, include information about your practice or organization, such as its name, address, and contact information.
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Step 6: Provide details about the services you offer and the areas of expertise in which you would like to be enrolled as a provider.
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Step 7: Attach any supporting documents required, such as proof of education, certifications, licenses, or accreditation.
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Step 8: Review the completed form for accuracy and ensure all required fields are filled out.
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Step 9: Sign and date the form.
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Step 10: Submit the OHA 3128 provider enrollment form along with any necessary supporting documents to the designated authority or department as instructed.

Who needs oha 3128 provider enrollment?

01
Individual healthcare providers, such as doctors, nurses, therapists, and other medical professionals, who wish to enroll as providers in the OHA network.
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Healthcare organizations, hospitals, clinics, and facilities that want to become enrolled providers and offer services through the OHA network.
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OHA 3128 provider enrollment is a process for healthcare providers to become enrolled with the Oregon Health Authority (OHA) in order to provide services to recipients of the Oregon Health Plan.
Healthcare providers who wish to participate in the Oregon Health Plan are required to file OHA 3128 provider enrollment.
OHA 3128 provider enrollment can be filled out online through the OHA website by providing accurate information about the provider and the services they offer.
The purpose of OHA 3128 provider enrollment is to ensure that healthcare providers meet all necessary requirements to participate in the Oregon Health Plan and provide quality care to patients.
Providers must report information such as their contact details, specialty, services offered, billing information, and any relevant certifications or licenses.
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